Abstract

ObjectivesThe study aimed to explore which discourses staff in crisis services draw on when discussing people in crisis. Further questions were; how those with borderline personality disorder diagnosis are positioned by these discourses and what the subsequent consequences are for people in crisis.

MethodTwelve staff members from home treatment, day treatment or acute ward teams were interviewed. Questions related to their experiences of people in crisis. Foucauldian Discourse Analysis was used to highlight the discourses used when talking about those in crisis.

ResultsFour main discourses were present in language used; ‘medical legal’, ‘personal responsibility’, ‘limited resources for the problem’, and ‘human experience and emotions’. People with a diagnosis of borderline personality disorder (BPD) were positioned differently to those with other diagnosis. Staff are positioned as experts needing to diagnose and cure distress. The discourse of human experience and emotions highlighted the emotional aspect of working with people in crisis, especially those with a BPD diagnosis.

ConclusionThe prevailing discourses within NHS crisis services remain those of the medical model, legitimising ideas of classic mental illness and practices of medication and control. This impacts the position of people with a BPD diagnosis. Further reflective spaces are required to highlight the flexibility of these discourses, practice, and the importance of emotions raised by those in distress.